Professor Joachim W. Thüroff: Applications and advantages of the daVinci® robotic surgical system in the field of urology

The Urology Department at Mainz University Medical Centre is highly experienced in performing operations using the daVinci® robotic surgical system. Professor Thüroff and his team have been using the system on a routine basis since 2007. Professor Thüroff is highly regarded around the world as a specialist surgeon for treating cancers of the kidneys, bladder and prostate.

Urology covers a broad spectrum of different operations, ranging from oncological surgery to reconstructive procedures. The Urology Department and Clinic at Mainz University Medical Centre offers the full range of treatments in this field. In recent years, there has been an increasing trend towards keeping surgical scars as small as possible and trauma to a minimum whilst maintaining a high rate of success and low rate of complications. The minimally invasive method (‘keyhole surgery’) is now a firmly established part of the urological spectrum and is always the preferred option for any operation whenever possible.

Mainz’s Urology Department has performed laparoscopies since 2002 and robot-assisted laparoscopies using the daVinci® system since 2007. This type of minimally invasive surgery is now an integral part of the urological surgeon’s armament and is used to treat conditions affecting almost all organs of the urinary tract.

Tumours of the kidney can be removed using minimally invasive, organ-preserving techniques; for patients suffering from prostate cancer it is often possible to carry out daVinci® prostatectomies in a way that maintains potency. Even for benign enlargements (where the prostate weighs over 100 grams) it makes sense to enucleate the gland using the robotic system. The system can also help to remove large stones in the ureter and to reconstruct the ureter in cases of constrictions (‘nephropyeloplasty’). It is also possible to correct a prolapsed bladder and diverticula (outward intestinal bulges) can also be removed in a minimally invasive procedure.

The benefits of robot-assisted keyhole surgery lie not only in the manner of access but also in the technical possibilities of the system itself. In minimally invasive procedures, surgical trauma is kept to a minimum, the wound heals more quickly, patients experience less pain and they recover faster. This is partly due to the reduced loss of blood, which is made possible by the very precise and detailed view that is presented during the operation. Two cameras operating in parallel give the surgeon a three-dimensional image that he can enlarge by up to twelve times the original size. Thanks to special hinges, the instruments are more dexterous than the human hand and offer seven degrees of freedom of movement and almost 360° rotation. Involuntary tremors of the human hand are also compensated for. This makes it possible to operate with great precision, which is of paramount importance particularly in meticulous phases of the surgery such as when cutting off the blood supply to renal tumours or when preserving the erectile nerves in radical prostatectomies.

Because the Urology Department at Mainz University Medical Centre was among the first to introduce the daVinci® robot in Germany, Professor Thüroff and his team have been able to acquire a vast amount of experience in all applications of the system.This is reflected by the many occasions that Professor Thüroff has been invited to other hospitals to demonstrate surgical practice using the daVinci® system and to pass on his expertise. Professor Thüroff and his experienced and well-coordinated team at the Urology Department in Mainz have performed numerous procedures using the daVinci® system and are able to carry out a wide range of surgical operations with great success.